Text message-based health interventions

Text message-based health interventions provide patients with reminders, education, or self-management assistance for a broad spectrum of health conditions. Interventions are most frequently used as a part of broader health promotion efforts or to help individuals manage chronic diseases (Tofighi 2017*). Text messages may be standardized or tailored to specific patients and sent at varied frequencies based on the intervention (Orr 2015). Text messaging can be combined with other approaches or delivered as part of a stepped care or progressive intervention that is tailored to patients’ needs, beginning with the least intensive treatment and moving to more intensive, and often expensive, treatments as needed (Tofighi 2017*). Text message software and smartphone apps can be integrated into electronic health records (EHRs) to send alerts and reminders to patients (Perri-Moore 2016).

Expected Beneficial Outcomes (Rated)

  • Improved health outcomes

  • Improved weight outcomes

  • Increased healthy behaviors

  • Improved chronic disease management

  • Increased tobacco cessation

  • Reduced tobacco use

  • Reduced drug and alcohol use

  • Increased vaccination

Other Potential Beneficial Outcomes

  • Increased medication adherence

Evidence of Effectiveness

There is strong evidence that text message-based health interventions improve health (Arambepola 2016, Poorman 2015, Hall 2015, Buhi 2013*, Cochrane-de Jongh 2012*, Cochrane-Horvath 2012*, Cochrane-Vodopivec-Jamsek 2012*) and weight outcomes (Job 2018*, Liu 2015a, Hall 2015, Poorman 2015, Siopsis 2015*, Buhi 2013*), and increase healthy behaviors (Schwebel 2018*, Loescher 2018*, Armanasco 2017*, L’Engle 2016*, Poorman 2015, Orr 2015, Hall 2015) for a variety of populations and in diverse settings. However, additional evidence is needed to confirm long-term effects.

Text message-based health interventions improve health outcomes for adolescents with chronic conditions (Badawy 2017a) and appear to be as effective as, and in some cases better than, usual care in the self-management of chronic illnesses such as hypertension (Cochrane-de Jongh 2012*), and can improve asthma self-management (Buhi 2013*). Such interventions improve health outcomes in diabetics (Arambepola 2016, Cochrane-de Jongh 2012*), including improved blood glucose levels (Poorman 2015, Buhi 2013*). For prediabetics, interventions can increase weight loss and improve blood glucose levels, especially for Spanish language speakers (Fischer 2016*). Text message-based health interventions improve weight loss (Job 2018*, Poorman 2015, Liu 2015a, Siopsis 2015*, Buhi 2013*) and reduce body mass index (BMI) for overweight or obese participants (Liu 2015a).

Text messaging, alone or with an internet-based component, has been shown to change health behaviors in the short-term (Buhi 2013*, Head 2013a*, Fjeldsoe 2009*) and in some cases has longer-term effects (Armanasco 2017*, L’Engle 2016*, Poorman 2015, Loescher 2018*). Such interventions increase tobacco cessation (Cochrane-Whittaker 2016*, Poorman 2015) and reduce tobacco (Scott-Sheldon 2016*, Mason 2015a, Loescher 2018*), alcohol (Loescher 2018*, Tofighi 2017*, Mason 2015a, O’Rourke 2016*, Gonzales 2016), and drug use (Loescher 2018*, Gonzales 2016), including methamphetamines and opioids (Tofighi 2017*). Text messaging interventions aimed at teenagers appear to reduce risky sexual behavior (L’Engle 2016*, Loescher 2018*), increase testing and treatment for sexually transmitted infections (STIs), and increase knowledge of sexual and reproductive health for teens of various races and genders (L’Engle 2016*).

Text messaging interventions increase vaccinations (Schwebel 2018*, L’Engle 2016*, Poorman 2015, Badawy 2017), including human papillomavirus (HPV) vaccines for adolescents (Rand 2017*, Rand 2015), and flu vaccines for Latino families (Stockwell 2015*) and mothers with low incomes (Jordan 2015*). An Anchorage-based study suggests that text messaging interventions increase colorectal cancer screening among Alaska Native and American Indian populations (Muller 2017) and international studies suggest they increase breast and cervical cancer screenings (Uy 2017). Interventions may also increase completion of outpatient cardiovascular rehabilitation (Lounsbury 2015*). Text message reminders increase appointment attendance (Schwebel 2018*) and appear to be as effective as telephone reminders (Cochrane-Gurol-Urganci 2013*).

Text messaging interventions can increase medication adherence (Schwebel 2018*, Tofighi 2017*, L’Engle 2016*, Orr 2015, Hamine 2015), including adherence by adults (Thakkar 2016*) and adolescents (Badawy 2017a) with chronic conditions such as asthma (Hall 2015, Loescher 2018*), diabetes (Hall 2015), and HIV (Hall 2015, Cochrane-Horvath 2012*). However, a study of schizophrenic patients suggests daily text message prompts added to standard care may not increase medication adherence more than standard care alone for this population (Cochrane-Kauppi 2014*).

Programs which use individualized coaching through smartphone texts can increase daily step counts and physical activity (Martin 2015a). Customized text support can also improve oral health and increase sun safety knowledge among adolescents (Badawy 2017).

In some cases, two-way text communication can be more effective than one-sided reminders (Vargas 2017). Tailoring messages and using participants’ preferred language may contribute to participant satisfaction with text message-based health interventions (Park 2014*). The intervention characteristics that are most beneficial will vary based on the specifics of the health condition addressed and population served (Schwebel 2018*, Loescher 2018*, Armanasco 2017*, Hall 2015).

Impact on Disparities

No impact on disparities likely

Implementation Examples

Text message-based health interventions are available at the national, state, and local level (IDPH-Text2Survive, U of U Health). One example is Text4baby, a free national health text messaging service and smartphone app for expectant and new moms. Texts are available in English and Spanish and include appointment reminders, information on baby milestones, nutrition, breastfeeding, labor, etc. (Text4baby, Mathematica-Text4baby 2015). The US Department of Veterans Affairs (VA) offers VEText, a text message service to remind veterans of upcoming appointments; reminders are sent seven days and then two days prior to an appointment (VEText). Text2Survive in Illinois allows minority youth and young adults to receive HIV/AIDS information and testing, including lists of nearby sites that offer free services, health events, and health tips (AHRQ HCIE-Halloway, IDPH-Text2Survive).

The University of Utah Health offers text message reminders for outpatient appointments (U of U Health), as does CHI Franciscan health care system in the Seattle and Tacoma areas of Washington (CHI Franciscan). The Healthcare Information and Management Systems Society’s (HIMSS’s) mHealth Roadmap provides guidance to hospitals and health care providers on implementing mobile and mHealth methods (HIMSS Mobile Health Roadmap). 

Implementation Resources

Handel 2011* - Handel MJ. mHealth (mobile health)-using apps for health and wellness. EXPLORE: The Journal of Science and Healing. 2011;7(4):256–61.

HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap.

Text4baby - Text4baby. Free text messages to keep you and your baby healthy. Wellpass healthcare messaging platform.

Citations - Evidence

* Journal subscription may be required for access.

Arambepola 2016 - Arambepola C, Ricci-Cabello I, Manikavasagam P, et al. The impact of automated brief messages promoting lifestyle changes delivered via mobile devices to people with type 2 diabetes: A systematic literature review and meta-analysis of controlled trials. Journal of Medical Internet Research. 2016;18(4):e86.

Poorman 2015 - Poorman E, Gazmararian J, Parker RM, Yang B, Elon L. Use of text messaging for maternal and infant health: A systematic review of the literature. Maternal and Child Health Journal. 2015;19(5):969-989.

Hall 2015 - Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: A systematic review of reviews. Annual Review of Public Health. 2015;36:393-415.

Buhi 2013* - Buhi ER, Trudnak TE, Martinasek MP, et al. Mobile phone-based behavioural interventions for health: A systematic review. Health Education Journal. 2013;72(5):564–83.

Cochrane-de Jongh 2012* - de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database of Systematic Reviews. 2012;(12):CD007459.

Cochrane-Horvath 2012* - Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database of Systematic Reviews. 2012;(3):CD009756.

Cochrane-Vodopivec-Jamsek 2012* - Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care. Cochrane Database of Systematic Reviews. 2012;(12):CD007457.

Job 2018* - Job JR, Fjeldsoe BS, Eakin EG, Reeves MM. Effectiveness of extended contact interventions for weight management delivered via text messaging: A systematic review and meta-analysis. Obesity Reviews. 2018;19(4):538-549.

Liu 2015a - Liu F, Kong X, Cao J, et al. Mobile phone intervention and weight loss among overweight and obese adults: A meta-analysis of randomized controlled trials. American Journal of Epidemiology. 2015;181(5):337-348.

Siopsis 2015* - Siopis G, Chey T, Allman-Farinelli M. A systematic review and meta-analysis of interventions for weight management using text messaging. Journal of Human Nutrition and Dietetics. 2015;28(s2):1-15.

Schwebel 2018* - Schwebel FJ, Larimer ME. Using text message reminders in health care services: A narrative literature review. Internet Interventions. 2018;13:82-104.

Loescher 2018* - Loescher LJ, Rains SA, Kramer SS, Akers C, Moussa R. A systematic review of interventions to enhance healthy lifestyle behaviors in adolescents delivered via mobile phone text messaging. American Journal of Health Promotion. 2018;32(4):865-879.

Armanasco 2017* - Armanasco AA, Miller YD, Fjeldsoe BS, Marshall AL. Preventive health behavior change text message interventions: A meta-analysis. American Journal of Preventive Medicine. 2017;52(3):391-402.

L’Engle 2016* - L’Engle KL, Mangone ER, Parcesepe AM, Agarwal S, Ippoliti NB. Mobile phone interventions for adolescent sexual and reproductive health: A systematic review. Pediatrics. 2016;138(3):e20160884.

Orr 2015 - Orr JA, King RJ. Mobile phone SMS messages can enhance healthy behaviour: A meta-analysis of randomised controlled trials. Health Psychology Review. 2015;9(4):397-416.

Badawy 2017a - Badawy SM, Barrera L, Sinno MG, et al. Text messaging and mobile phone apps as interventions to improve adherence in adolescents with chronic health conditions: A systematic review. JMIR mHealth and uHealth. 2017;5(5):e66.

Fischer 2016* - Fischer HH, Fischer IP, Pereira RI, et al. Text message support for weight loss in patients with prediabetes: A randomized clinical trial. Diabetes Care. 2016;39(8):1364-1370.

Head 2013a* - Head KJ, Noar SM, Iannarino NT, Grant Harrington N. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Social Science & Medicine. 2013;97:41-8.

Fjeldsoe 2009* - Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. American Journal of Preventive Medicine. 2009;36(2):165–73.

Cochrane-Whittaker 2016* - Whittaker R, McRobbie H, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Systematic Reviews. 2016;(4):CD006611.

Scott-Sheldon 2016* - Scott-Sheldon LAJ, Lantini R, Jennings EG, et al. Text messaging-based interventions for smoking cessation: A systematic review and meta-analysis. JMIR mHealth and uHealth. 2016;4(2):e49.

Mason 2015a - Mason M, Ola B, Zaharakis N, Zhang J. Text messaging interventions for adolescent and young adult substance use: A meta-analysis. Prevention Science. 2015;16(2):181-188.

Tofighi 2017* - Tofighi B, Nicholson JM, McNeely J, Muench F, Lee JD. Mobile phone messaging for illicit drug and alcohol dependence: A systematic review of the literature. Drug and Alcohol Review. 2017;36(4):477-491.

O’Rourke 2016* - O’Rourke L, Humphris G, Baldacchino A. Electronic communication based interventions for hazardous young drinkers: A systematic review. Neuroscience & Biobehavioral Reviews. 2016;68:880-890.

Gonzales 2016 - Gonzales R, Hernandez M, Murphy DA, Ang A. Youth recovery outcomes at 6 and 9 months following participation in a mobile texting recovery support aftercare pilot study. The American Journal on Addictions. 2016;25(1):62-68.

Badawy 2017 - Badawy SM, Kuhns LM. Texting and mobile phone app interventions for improving adherence to preventive behavior in adolescents: A systematic review. JMIR mHealth and uHealth. 2017;5(4):e50.

Rand 2017* - Rand CM, Vincelli P, Goldstein NPN, Blumkin A, Szilagyi PG. Effects of phone and text message reminders on completion of the human papillomavirus vaccine series. Journal of Adolescent Health. 2017;60(1):113-119.

Rand 2015 - Rand CM, Brill H, Albertin C, et al. Effectiveness of centralized text message reminders on human papillomavirus immunization coverage for publicly insured adolescents. Journal of Adolescent Health. 2015;56(5 Suppl):S17-S20.

Stockwell 2015* - Stockwell MS, Hofstetter AM, DuRivage N, et al. Text message reminders for second dose of influenza vaccine: A randomized controlled trial. Pediatrics. 2015;135(1):e83-e91.

Jordan 2015* - Jordan ET, Bushar JA, Kendrick JS, Johnson P, Wang J. Encouraging influenza vaccination among Text4baby pregnant women and mothers. American Journal of Preventive Medicine. 2015;49(4):563-572.

Muller 2017 - Muller CJ, Robinson RF, Smith JJ, et al. Text message reminders increased colorectal cancer screening in a randomized trial with Alaska Native and American Indian people. Cancer. 2017;123(8):1382-1389.

Uy 2017 - Uy C, Lopez J, Trinh-Shevrin C, et al. Text messaging interventions on cancer screening rates: A systematic review. Journal of Medical Internet Research. 2017;19(8):e296.

Lounsbury 2015* - Lounsbury P, Elokda AS, Gylten D, et al. Text-messaging program improves outcomes in outpatient cardiovascular rehabilitation. IJC Heart & Vasculature. 2015;7:170-175.

Cochrane-Gurol-Urganci 2013* - Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database of Systematic Reviews. 2013;(12):CD007458.

Hamine 2015 - Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: A systematic review. Journal of Medical Internet Research. 2015;17(2):e52.

Thakkar 2016* - Thakkar J, Kurup R, Laba TL, et al. Mobile telephone text messaging for medication adherence in chronic disease: A meta-analysis. JAMA Internal Medicine. 2016;176(3):340-349.

Cochrane-Kauppi 2014* - Kauppi K, Välimäki M, Hätönen H, Kuosmanen L, Warwick-Smith K, Adams C. Information and communication technology based prompting for treatment compliance for people with serious mental illness. Cochrane Database of Systematic Reviews. 2014;(6):CD009960.

Martin 2015a - Martin SS, Feldman DI, Blumenthal RS, et al. mActive: A randomized clinical trial of an automated mHealth intervention for physical activity promotion. Journal of the American Heart Association. 2015;4(11):e002239.

Vargas 2017 - Vargas G, Cajita MI, Whitehouse E, Han H-R. Use of short messaging service for hypertension management: A systematic review. The Journal of Cardiovascular Nursing. 2017;32(3):260-270.

Park 2014* - Park LG, Howie-Esquivel J, Dracup K. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence. Journal of Advanced Nursing. 2014;70(9):1932-1953.

Citations - Implementation Examples

* Journal subscription may be required for access.

IDPH-Text2Survive - Illinois Department of Public Health (IDPH). National Black HIV/AIDS Awareness Day. IDPH Center for Minority Health Services’ Text2Survive program.

U of U Health - University of Utah Health (U of U Health). Patient and family services: Text message reminders for your appointment.

Text4baby - Text4baby. Free text messages to keep you and your baby healthy. Wellpass healthcare messaging platform.

Mathematica-Text4baby 2015 - Promoting maternal and child health through health text messaging: An evaluation of the Text4baby Program— summary of key findings. Princeton: Mathematica Policy Research for the Health Resources and Services Administration, US Department of Health and Human Services (US DHHS); 2015.

VEText - US Department of Veterans Affairs (VA). VEText: an interactive mobile solution to remind veterans of upcoming appointments.

AHRQ HCIE-Halloway - Halloway V. Texting service enhances minority youth access to HIV/AIDS information and testing. Rockville: AHRQ Health Care Innovations Exchange.

CHI Franciscan - CHI Franciscan. Appointment reminders. Seattle and Tacoma, Washington.

HIMSS Mobile Health Roadmap - Health Information and Management Systems Society (HIMSS). Mobile Health Roadmap.

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